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groups). It was the latter group who were considered to have prolonged fatigue burden and
therefore to represent those most in need of fatigue interventions.
Few demographic or clinical variables characterised female non-improvers, though they
were significantly younger than Improvers (51.7 (14.5) vs 59.2 (14.2), p<0.001), with
statistically, but not clinically, significant higher baseline disease activity (4.67 (1.15) vs 4.16
(1.08), p=0.003). More non-improvers were using antidepressants (12.9% vs 1.2%, p=0.003)
and NSAIDs (49.7% vs 32.1%, p=0.01) at baseline, and a higher proportion had a history of
depression than improvers (44.5% vs 16.25%, p<0.001).
As in the male participants, patient-reported variables were more consistently informative
as to the existence of between group differences, as those following non-improved
trajectories reported a clinically and statistically significantly poorer baseline health state.
This was evidenced by the reporting of more disability (1.30 (0.69) vs. 1.06 (0.66), p=0.01),
pain (53.0 (23.8) vs. 40.8 (35.6), p<0.001), fatigue (63.8 (20.8) vs. 49.9 (19.6), p<0.001), sleep
(54.3 (29.2) vs. 41.2 (27.3), p<0.001) and stomach problems (26.5 (27.1) vs. 16.0 (25.0),
p=0.004), than those who followed an improved trajectory.
Discussion
This analysis has demonstrated that in patients with RA, the longitudinal course of fatigue is
better characterised by the adoption of discreet symptom trajectories, rather than
examining average changes. In particular, the longitudinal course of fatigue differs between
the sexes, with an additional chronic trajectory observed in females. We identified
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